Monthly Archives: March 2016

Failure to recruit more GPs raises safety fears – don’t say you weren’t warned.

Kate Gibbons in the Times 28th March reports: Failure to recruit more GPs raises safety fears and provides the GP slant on the reality of the previous posting. Stress levels in junior  doctors, and fear in all staff is leading to implosion. (Collapse, fear and disorder. A post-coded anarchy of lowering medical quality and standards is coming… ) NHSreality has warned for 3 years…. Denial is the politicians problem. Disengagement is a problem for Drs and politicians.

Fewer than half the new GPs that the government promised to recruit will have joined the profession by 2020.

Jeremy Hunt, the health secretary, announced plans to train and retain an extra 5,000 GPs in England by the end of the decade at the Conservative party conference in 2014.

However, just over 2,000 are expected to join and the number of unfilled GP posts continues to rise. Senior doctors have warned that patients’ lives are at risk as struggling emergency departments are forced to pick up GPs’ workload and the health service has been forced to turn to the private sector for expensive agency staff as emergency services, GPs and out-of-hours NHS services fail to cope.

Analysis of the figures, carried out by Pulse magazine, shows that the GP workforce will increase by 2,100 at best, despite a £10 million recruitment scheme that includes “golden hellos” of £20,000 and a high-profile government publicity campaign.

New figures from the Royal College of General Practitioners show that in 16 areas of the country, including large parts of Kent, London, Dorset and Gloucester, more than 25 per cent of GP posts are empty. Among the worst hit areas are Bexley in southeast London, Redbridge in northeast London and Swale in Kent, which all have about half the number of doctors needed to cover their population.

The British Medical Association called the health secretary’s 2014 pledge wholly unrealistic. It estimates that at the current training rate 13,000 GPs will enter the system by 2020. However, 3,500 GPs have applied for certificates to work abroad and 7,200 are likely to have retired.

Krishna Kasaraneni, chairman of the BMA GP education, training and workforce subcommittee, said that the data analysis revealed how short they were likely to be. He added: “We actually need a lot more GPs than this arbitrarily chosen figure [of 5,000] to maintain a basic level of service to patients. With 600 GP trainee posts left unfilled last year and large sections of the workforce telling the BMA they intend to retire, there is little chance the government will get anywhere near this target.”

Figures from the General Medical Council, the regulator, show that 700 GPs in England are applying to work abroad each year and the NHS Business Services Authority, which administers NHS pensions, said that about 1,400 GPs retired in 2014. The 2020 predictions do not take into account any increase in GPs taking early retirement. A BMA survey last year found that one in three GPs hoped to give up work in the next five years.

Application numbers will also be affected by the new junior doctor contracts, according to the BMA.

The government recently started to emphasise that the target was for 5,000 extra “doctors in general practice” rather than fully-qualified GPs, which means trainees will be counted. A Department of Health spokesman said that NHS training bodies were working with the BMA and royal college to boost recruitment. He added: “We have been clear that our target includes [trainees].”

Image result for gp recruitment cartoon

And just to confuse you, and make you question the manpower planning completely the Abi Rimmer in BMA news reports: Sugical Training Posts could be reduced to avoid oversupply. (BMJ careers 13th Feb 2016) – the opposite of 6 years ago when, in The Telegraph 1st May 2010 Rebecca Smith warned: Cuts being made to junior doctors’ posts experts warn – Up to one in three jobs for trainee surgeons will be cut over the next three years in some areas meaning doctors will be ‘spread too thinly’, it has been warned.

Overcapacity is the best way to control supply within a profession. 10% discard rate allows for emigration and career changes and drop outs..

Collapse, fear and disorder. A post-coded anarchy of lowering medical quality and standards is coming…

The level of distress and alienation among junior doctors taking strike action is a ‘matter of serious concern’, the GMC chairman has warned.

Link to article at GP magazine

Collapse and disorder. A post-coded anarchy of lowering medical quality and standards is coming… Undercapacity is the rule in 2nd and 3rd world countries, but we do not expect it in the UK. The reality has yet to strike the ublic, until they are ill themselves. Sometimes they realise when its their nearest and dearest who are rationed (restricted, excluded, prioritised, denied, delayed). Further evidence is in the articles below:

Skinhead can't get swastika right. Other man says: 'Maybe you should think about becoming an anarchist like me.'

Sarah-Kate Templeton in the Sunday Times 27th March reports on an incident/anecdote which is symptomatic of the whole. Baby death may lead to more doctors,

THE tragedy of a baby who died when no consultant was available in the hospital to help with her complicated delivery has prompted a review of staffing guidelines following the intervention of the minister for maternity care.

Ben Gummer has alerted the National Institute for Health and Care Excellence (Nice) and the Royal College of Obstetricians and Gynaecologists to concerns raised by a coroner over the absence of a consultant obstetrician during the birth of Bonnie Strachan at Ipswich Hospital in January 2015…..

The social contract whereby staff are protected is also being challenged. The legal issues involved are explored by Dr Narinder Kapur  in The Times 18th March 2016 :Discipline in the NHS and the death of Amin Abdullah

The fear of whistleblowing is endemic. The powerful gagging which is in all but a few of the Trusts in the UK medical services is a disgrace. The disciplinary procedures are so cumbersome and pedantic that the service itself is at risk. Trusts in “special measures” are not necessarily the only ones with the problem of bullying and inept management. The perverse incentives that drive these inhibitions need to be addressed. It may be too late to do this at National level. My personal belief is that the Trusts have to be made completely independent (an acknowledgement that there is no NHS) before the whole is re-formed – under a new constitution which recognises the need for overt rationing, the encouragement of autonomy, and allows teams to determine their own destiny with pride.

Read the whole dismaying article here: Discipline in the NHS and the death of Amin Abdullah

The lack of exit interviews throughout the health services is reflected in the feelings of the cleaning staff at the Maudesley. Uncherished and undervalued. One of the problems Trust boards and CCGs have is that when services are contracted out they feel no obligation to cherish, value or listen to these staff.

Nadine Houghton on 21st March writes in the Guardian: Why we should listen to the cleaners on strike at the Maudsley hospital

In an un-rationed health service that addresses fear without reference to means, PrEP should of course be funded. It is reasonable not to fund, but unreasonable not to call this rationing.

Nicola Slawson reports in The Guardian 21st March 2016: NHS England stalls plans for HIV prevention method known as PrEP

Consultation on Truvada will now be shelved, in move sexual health charities have described as ‘shameful’ and ‘failing those at risk’ of HIV

This is just the start of civil unrest. The patients will cause a lot more problems than the doctors. Strike won’t cure sick NHS

The start of “Civil Unrest” in the Regional Health Services – as predicted by NHSreality?

Cartoon: Anarchy of grandchild (medium) by bgurcay tagged anarchy,cartoon,comic

Liberal beliefs need to be modified pragmatically to create a sustainable health service – especially in Wales

This site has been running for 3 years, and the majority of readers are professionals in the Health Services and supporting areas. You can follow by either registering ” on site” or by asking me to “link in” or become friends through facebook. For twitter feed you do not need to link and I have no idea of how many followers of NHSreality there are. Please spread the word with the link to all your contacts… the former NHS has gone, and the Regional Health Services are dying. There is now no NHS according to WHO: but we were all of us children of the original NHS.. Politicians are in denial and letting everyone down with their dishonesty..

The new philosophy of honesty and the inconvenient truth of covert rationing is explained,


in the beginning we pointed out the impossibility of quality and cost objectives both being met.

Recently another GP, John Evans from Solva has joined me in postings. He and I have different positions on the EU but otherwise we concur on the UK health services.

The major theme is that as a mutual all health services are more powerful if they are larger. They can offer more specialist services, more choice, and better outcomes. We feel that there is no longer, in practical ways that apply to citizens/patients, a National Health Service.

We believe obfuscation and denial, by politicians and the media, has led to a situation where the professionals no longer believe that their health service is founded on a rock, either ideologically or financially.

The result has been increasing “covert rationing” as technology and information advances faster that the state’s ability to pay.

The outcome of this is an increasing health divide. Those who can choose to exercise choice and go privately. Those who cannot suffer longer waiting times, lack of choice, worse outcomes and in the end this will lead to shorter lives.

Our suggestions are several and have (some of them) been adopted by BMA Wales. Meetings have poor turnouts due to a disengaged profession but those who have done have been persuaded. The suggestions all address the longer term. We have no solutions to GP and Nurse shortages in the shorter term other than importing them, as we have done in the past. If we do this standards will fall and opportunities for our own to train and find work will be reduced in the same cycle of undercapacity as we entered in the 1960s. To protect a longer term solution imported staff should be on 10 year visas with renewable options at the discretion of local authorities.


  1. Exit interviews should be done on all Health Service Staff, especially nursing sisters, consultants and board members, by an independent HR body. These should be summarised and fed back to Deaneries, Trust Boards and the Ministers in a depersonalised way at 6 monthly intervals. Retiring staff should have the option to put their exit interview in the public domain, provided it is not libellous.
  2. Rationing should be made overt. Trust boards should be free to ration low cost high volume services in their area. Regions should make the rationing decisions at Regional level for the low volume high cost treatments. Obviously, we can have more of the latter if we have less of the former.
  3. Medical Training should be “post-graduate” and not undergraduate. (Gender bias dealt with) and the Deaneries should be forced to send their students out into the periphery, where they will be based on DGHs. They need only attend Cardiff for assessments, and most teaching and tutorials can be “on line”. In this way doctors and nurses will become part of a community at a younger age, and more likely to stay.
  4. Whistleblowers need to be the first people in the honours list. The educational portfolios should have a “bullying” and a “poor culture” button which alerts the educational supervisor and the Deanery concurrently. The trainee should be taught how to protect himself by only entering such reports once he has been signed up.
  5. Elected representatives need their constituencies to be coincident with “health Areas” so that perverse decisions are less likely and exposed.. PR of any form will help less perverse incentives and outcomes such as the one to destroy the chances of a new build hospital at Whitland/Narberth some 8 years ago. Health boards need to be equally representative, and debates about ideology conflicting with finance need to be overt.
  6. In the end people will never be completely happy with a health service, but they will appreciate the inconvenient truth: we cannot have everything for everyone for ever. Pragmatic and overt rationing whereby citizens know what is not available to them is better.
  7. Fairness may demand different levels of rationing for those on different incomes.
  8. Co-payments for example could be geared to income tax codes, through an identity card. This would be revolutionary, but such a card could be used at times of war (the new war may be constant and terrorist related)

to monitor movements at all transport points, used for bank account entry etc. I appreciate this is illiberal, but it is a debate we need before the big terrorist event rather than after. Liberal need to think, in all our policies, where liberty ends. If the benefit to society justifies a relatively small loss of liberty then I support it. For example, ID cards at transport points could be discarded if things look up.

  1. One health authority for 3m people in Wales is sufficient. It would win the votes of most of the health professionals as they would regain choice. Why did we vote against Plaid?
  2. All health services should have the true cost printed on them, and the cost to the patient alongside. If “free” or a co-payment it matters little. Prescription charges could be reintroduced on a sliding scale if we linked to an ID tax card. Charges might be pragmatic for A&E(higher for drunks), and for GP visits, once again with sliding scales.
  3. Foreign Nationals without an E111 would be charged immediately by bank card.

I look forward to Greek style  debates on some of these issues. If we do not put our Welsh Health Service on a secure financial footing we are going to perpetuate the opposite of what Aneurin Bevan intended, and increase inequalities. It has already happened in Dentistry and Physiotherapy, (and Legal Aid), and shortly it will happen – private GPs will begin.

A new philosophy, what I believe: allow Trust Board members to use the language of rationing in media press releases

Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS

A reminder in poetry: “I am a child of the NHS”

A poem a day will keep your loss of empathy at bay, doctor

London GP services crisis pending… Overseas doctors will probably fill the vacancies. Watch for private GPs and Private A&E departments in the capital…




A miracle is needed this Easter – for the UK Health Services. Hubris after grounding will not be enough..

NHSreality has already commented on the need for a miracle. Denial is part of the Easter story and the cock is crowing for Mr Hunt. His negotiations with the consultants are at risk in the same way as those with the juniors. Trying to solve a problem of 20 years in the incubation in a week is the impossible miracle that is needed. Whilst the rich people of Hampstead will exercise choice, by pass waiting lists and queued rationing, those in Scunthorpe (Wards closed) and Hastings (Special Measures) will have to put up with what they get. E.g.: Alan Travis in The Guardian 24th Feb 2016: Ministers and NHS bosses criticised over use of overseas nurses: Chief of government’s migration advisory committee says there is ‘no good reason’ why nurses cannot be found in UK. On the same day Dennis Campbell reports Sir Bruce Keoch, also in denial: Junior doctors row has derailed seven-day NHS plans, says top doctor. Sir Bruce Keogh signals unhappiness with Jeremy Hunt’s decision to impose contract and rejects justification of new terms

The Health Service miracle will not come of course. Icarus could not fly and neither can Mr Hunt or the Staff. Pigs do not have wings.. and they do not fly well in hurricanes…. (Adam Roberts 24th March 2016 in The Guardian: The NHS is in the midst of a financial hurricane )



The truth came home to Dr Megan North reflects on her life saved by her own intervention 4 years ago. The Guardian 25th Jan 2016: I nearly died because the hospital was so short of staff . This type of standard reduction is commonplace, universal, endemic… The people of Hampstead know it… and vote with their feet. The Doctors and Nurses know it and are voting with theirs.. The MPs know it and go privately.

The cock crowed 3 times for Paul, and he relented and told the truth. Mr Hunt, please relent and realise that overt rationing is the only realistic and pragmatic way to provide the miracle needed. Once on the ground the health services can never take off again, and hubris will not be enough.

Not only patients will need a miracle – the UK Health Trust Boards and CCGs need to go to Lourdes

In the news today:

Giles Sheldrick in the Express 24th March 2016: Holiday rush to A&E could cost the health service £10 MILLION NON-urgent visits to hospital accident and emergency departments over the Easter weekend could cost the cash-strapped NHS almost £10million, it was claimed last night.

The Sun reports: NHS at breaking point as patients overwhelm A&E. Third world NHS. 12 Hospitals in Crisis. Worst waiting times in 10 years.

Alan Travis in the Guardian reports on another denial: Ministers and NHS bosses criticised over use of overseas nurses -Chief of government’s migration advisory committee says there is ‘no good reason’ why nurses cannot be found in UK

GP practices face £20,000 losses as federation goes bust

Are GP Federations the so called saviour of General Practice already failing ? If APMS providers ( Like the one in the article below) cannot survive ( usually on much more money per patient than a GMS provider) then what hope for the rest of the GP network ?

A GP federation providing APMS services for 37,000 patients has gone into administration after running into financial difficulties leaving local GPs thousands of pounds out of pocket.

According to the article below  from PULSE magazine

14 March 2016 By

Danum Medical Services Ltd (DMSL) is a private limited company set up in Doncaster by the 23 local shareholding practices – which DMSL’s website says ’equates to 63 individual shareholding GPs’ – which holds APMS contracts for six practices in the Midlands and Yorkshire.

The company previously held major contracts for an extended hours hub and GP out-of-hours services in Doncaster, but hadn’t managed to secure them again when the contracts expired and went out to competitive tender last year.

Pity the NHS—Jeremy Hunt has chosen the nuclear option. Pity the patients: Its going to get worse.

Mary McCartney in BMJ 12th Feb write: Pity the NHS—Jeremy Hunt has chosen the nuclear option. Pity the patients: Its going to get worse. The options to make a change for the better in the next decade have gone. Improvement is more less likely than the cow jumping the moon.. And the impression each strike makes on “Steer”  Hunt is minimal.

Pity the NHS—Jeremy Hunt has chosen the nuclear option (BMJ 2016;352:i909 )

Why are junior doctors low in morale? Asking this while imposing the junior doctors’ contract is akin to wondering who started the fire as Jeremy Hunt holds a box of matches, an empty can of petrol, and a sign saying, “I did it.” Sorry, not a fire: it’s “the nuclear option.” Why would junior doctors—post-MTAS, in debt, on rotten shifts, and with the Antipodes calling—possibly feel demoralised?

The moral contract between healthcare professionals and patients is the one that matters more. The reason why we have the stress of leaving late, starting early, and fixing problems that “technically” aren’t ours is because we work for patients, not the secretary of state. And so, even though it’s “not my job,” I’ll do it—because I know that if I don’t, it will get done more slowly or not at all, causing avoidable delay or suffering.

Every professional does this, every day. We do it because we want to do good work, and because we love our work. This vocation is part of our human identity, and it means that when work goes wrong we’re upset, and when it goes well we’re joyful. For all of the strain and stress and petty bureaucracy, the NHS is a phenomenal achievement conjured up every day by the people who choose to go and make it.

This, however, may stop. Treat people as you would like to be treated: people at work need respect, kindness, and enough resources. Imposing a new contract will lead to none of these. In many parts of the United Kingdom, junior doctors and consultants have adjusted their working patterns to suit local needs within the current contract: Wales and Scotland have no plans to change.

Junior doctors already work in a 24/7 system. When Hunt spoke in parliament of juniors taking on “bonus” shifts, he seems not to have realised that nights and weekends are not optional. Doctors will leave, many will not return, and we will have fewer staff in an even less safe NHS.

The NHS is being set up to fail. It’s easy to see how the proliferating private GP companies will profit while the NHS, starved of essential resources, is told that it’s not hitting targets and is punished as a result. It will haemorrhage even more staff who hate their lack of ability to provide good care with the resources (not) available.

The NHS will then have its bones plucked by whatever private companies are watching and biding their time. This is a disaster for everyone that cares about our NHS.

Not only patients will need a miracle – the UK Health Trust Boards and CCGs need to go to Lourdes

Frank Field in the Guardian Tuesday 23rd February 2016 appreciates there is no miracle cure: The NHS is our national religion – but there’s no miracle funding cure – It’s time for a Bevan-type reform of health finances – the public would make greater NI contributions into a ringfenced mutual organisation to secure the NHS’s future

Not only patients will need a miracle – the Trust Boards and CCGs need to go to Lourdes. Voters are not committed in droves – they are more and more cynical. This is the result of numerous honest conversations with GPs and Doctors and Nurses throughout the system. Mr Field has it wrong. Its wishful thinking only.. And the miracle cure does not exist. One of the worst areas is Paediatrics, where the drop out rate is very high.

The NHS is the one postwar act to which the public are committed. It has become, in Nigel Lawson’s indicative phrase, Britain’s national religion. That is why politicians invariably play safe, knowing that the gods can most easily be assuaged with offerings of money. Yet the gods are getting more and more demanding and we live in an age of public austerity.

It must be doubted if the government believes its own rhetoric on safeguarding the NHS budget in real terms. NHS inflation is higher than the government calculates, the older we get as a nation the greater our health demands, and modern technology feeds that demand. So is the solution simply more money? The answer is an emphatic “yes”, but in assuaging the gods we need to change fundamentally the politics of health.

Here is where the public’s view of national insurance contributions could come to the rescue. The public do not regard an increase in NI contributions as a tax increase. A few of us pushed under New Labour for a broader funding of health and welfare by making NI contributions progressive and shifting these costs onto this new revenue base. Paying in before drawing out is the bedrock of what voters see as fair.

The financial catastrophe into which the NHS is beginning to tumble (already a record number of hospitals have tipped over to emergency loans from government) will slowly begin to shut down parts of the NHS as we know it. Maybe at that point, or before – if it wants to look smart – the government will open up discussions on a new funding basis for health and extend that to social care. It might even get away with the current NI contributory base, but peace at this price won’t last long.

Now is the opportunity for an Aneurin Bevan-type reform of NHS finances. Last year, I proposed the creation of a new NHS mutual organisation that debates with us, (the potential contributors), and the government, a rolling financial budget for the NHS.

The election came and went, with none of the main parties pledging anywhere near enough extra cash to meet the projected shortfall in the NHS budget. Hence why it now finds itself having to find an additional £22bn of savings by the end of the parliament. If these savings are to be achieved, voters are likely to have experienced a marked deterioration in their standards of care. The need for reform, as well as a buoyant new source of revenue, has therefore become doubly urgent.

Voters have made it clear that they are willing to make an additional financial contribution to the NHS. In 2002, when Gordon Brown put a penny increase on NI contributions the public cheered him. They may have been less enthusiastic had they known that a little under half the money thereby raised was siphoned off to other New Labour pet projects. Perhaps with this in mind, their willingness this time round to make an additional contribution is contingent on any new monies being used to drive an ongoing programme of reform that delivers a 21st century health and social care service.

Voters will not entertain the prospect of writing politicians a blank cheque to prop up a failing health service. Nor will they tolerate ever greater sums being transferred from other budgets as a quick fix to try and prevent the black hole in the health budget from growing. Having a mutual body that ringfences NI contributions for health and social care, and also presents us with what a modern health service costs, could see the NHS through the next 20 years. Agreement lasting four parliaments would be no mean achievement.

NHS doctor vacancies are 7.8% in Wales

Kailash Chand in GPonline reports29th Feb 2016: GP crisis: Ministers must listen to NHS staff and tackle the workforce crisis

Pennington manches LLP solicitors comments 2nd March 2016 on NHS staff shortages – the impact on maternity care

Paediatrics workload deters doctors, suggests BMA

Severe shortage of GPs is reaching crisis-point in Derbyshire – only 37% of GP training places filled – due to political rationing of Medical School places 10 years ago, and the shape of the job

Only 52% of doctors completing foundation training chose to enter specialty training

Helen Jacques in BMA news reports 12th Jan 2013: Royal college reports attrition and dissatisfaction among paediatrics trainees

One in 10 trainees in paediatric medicine drops out by specialty training year 3 (ST3), and over 40% have seriously considered leaving the specialty, the Royal College of Paediatrics and Child Health has found.

The findings come from a pair of surveys conducted by the college.[1] [2]

A cohort study of 354 paediatric trainees (81% response rate) who began training in the specialty in 2007 found that 11% were training in another specialty or working in another career.[1] This indicates an attrition rate of 5% a year between ST1 and ST3, the college said.

Half (51%) of the trainees no longer in paediatrics had moved to a career in general practice, and 13% had left medicine. Nevertheless, 71% of respondents said that they were happy that they chose paediatrics as a career.

A second online survey of 2037 paediatric trainees, representing a response rate of 56%, found that 41% had seriously considered leaving paediatrics.[2]…..

Victoria Bishoff in The Mail 22nd December 2015 reports: NHS won’t pay for £60k miracle cancer drug, but your insurer might… we reveal those that will

The Government and NICE. Income and expenditure. Rationing by exclusion – but covertly

Expenditure is in the news, particularly on Social Care. Two years ago it was predicted: now it is reality (Tejvan Pettinger in economics 5th Dec 2014).  In “Unsweetened medicine” on Kick-starting the economy, particularly the economy in Wales or Scotland is not easy. NICE which has technically been rationing since its inception, may have to reduce it’s cost effectiveness thresholds if the chancellor has it wrong. Their work has also been undermined by the “cancer drugs fund” (Sarah Boseley in the Guardian 5th Feb 2016: Government has no idea about Cancer Drugs Fund’s impact, MPs say ).

Crossing the line (BMJ2016;352:i1336) written by John Appleby makes it clear that if the chancellor is wrong the “threshold” for “Quality Of Life Years might have to be reduced.. His graphics on rationing are at the foot of this post. Rationing by exclusion – but covertly is happening now, but it is addressing high value low volume items. NHSreality wants the nation to address low value high volume items as well.

The chancellor has little room for manoeuvre and doesn’t want to remind us again and again that we are overspending.  In The Times 22nd March 2016 you can find the latest expense graphic:

Expenditure 2016

But income is stagnant or falling and as (arguably more) important.


So we have a deficit. And Social Services takes up more than Health in the first graphic. Savings there are important.

There are complex rules for disabled people getting funds, and their interpretation is different in each region (Post code rationing), especially in dementia care:

Complex rules

The future planned by the chancellor on receipts and expenditure depends on a working population, and in the poorer regions this amounts to public servants. The Greek solution over many years was to appoint more public employees to get short term PAYE tax receipts. Tax avoidance by the self employed and the private industries is an impossible problem there:


The jobless total is falling and the accelerating slope of the curve since 2011 is impressive.

So will Quality Of Life Years” value index need to be as changeable as the budget? John Appleby’s graphs are below. If we don’t produce, or expand the economy we should all know what will happen. In parts of the nation with highest unemployment votes will go to those who promise more benefits and the nation gets more and more polarised.





Stephen Bolsin – Bristol Scandal Whilstleblower mock interview in BMJ confidential. The duty of candour shows no sign of overriding the culture of fear and bullying.

What more to say? Read the Kennedy inquiry and reflect if anything has changed? Hospitals are still told to stop gagging NHS whistleblowers in 2015… and no awards (MBE, OBE) have been given to Dr Bolsin and the other heroes of our UK Health Services. The duty of candour shows no sign of overriding the culture of fear and bullying.

Who do managers wish to recruit?

Why don’t people speak out at the top level?

The BMJ (BMJ2016; 352:i328) published 12th March 2016, some 15 years on.

Stephen Bolsin, 63, is the gnawing conscience of the NHS in England, the man who blew the whistle on failings in paediatric heart surgery at Bristol Royal Infirmary and was rewarded with the sound of slamming doors. An anaesthetist appointed as a consultant in Bristol in 1988, Bolsin recognised and tried to remedy failings in the service, finally turning whistleblower. This led to the Kennedy inquiry (2001), which vindicated his concerns and was a landmark in clinical governance. He subsequently found it impossible to find another position in the UK and moved to Australia, where he became director of critical care services at Geelong Hospital in Victoria, achieving world class outcomes with the adult cardiac anaesthetic service he started. He has honorary professorial positions at Monash and Melbourne Universities.

What was your earliest ambition?

To drive steam engines.

Who has been your biggest inspiration?

My parents were both inspirational people. They met as Christian missionaries in India just after the partition, and their courage, compassion, and honesty made them role models.

What was the worst mistake in your career?

Accepting the position of consultant cardiac anaesthetist at Bristol Royal Infirmary. That decision led to some of the worst years of my professional life.

What was your best career move?

Accepting the position of consultant cardiac anaesthetist at Bristol Royal Infirmary. My time in Bristol strengthened my ethical and family values, while helping to establish clinical governance in medicine.

Bevan or Lansley? Who has been the best and the worst health secretary in your lifetime?

The worst in my lifetime was Keith Joseph, who wasted millions of NHS pounds by introducing an extra tier of management between districts and regions, called areas. They were quietly removed after a suitable interval. The best was Iain Macleod, who courageously supported the Family Planning Association and thus increased equality for women. He also supported legalising abortion and decriminalising homosexuality, and he opposed the death penalty.

Who is the person you would most like to thank, and why?

My wife, Maggie, for her unwavering support and understanding, particularly throughout Bristol; and Baroness Primarolo and Baroness Corston, for believing in me enough to raise questions in the House of Commons, which eventually broke the silence on the Bristol scandal.

To whom would you most like to apologise?

Mandy Evans, Joshua Loveday’s mother. Joshua was scheduled for the last switch operation in Bristol before the reorganisation of paediatric cardiac surgery. Maggie and I agonised over warning Joshua’s parents when we thought Joshua’s operation might proceed. When I was told by the Department of Health that the operation should not take place in Bristol, I believed that Joshua was safe. I was devastated when his operation went ahead despite the appalling record in Bristol. I’ll always regret not giving Mandy the chance to judge my concerns for Joshua’s safety herself, and I’m sorry for failing to save Joshua’s life.

If you were given £1m what would you spend it on?

I’d invest it on improving healthcare for patients using technology.

Where are or were you happiest?

Some of my happiest memories are of rugby tours to Ireland with the University College Hospital Pelicans rugby team, and of cricket matches on English village greens.

What single unheralded change has made the most difference in your field in your lifetime?

Technically, the laryngeal mask has made the biggest difference to my specialty of anaesthesia in my clinical lifetime. Clinical governance across medicine wasn’t predictable when I trained, but it’s made a huge difference to medicine and is the sole positive thing to emerge from the Bristol scandal.

Do you support doctor assisted suicide?

Yes: people who are seriously ill and suffering should be helped, if they wish to end their lives, by conscientious and courageous doctors.

What book should every doctor read?

Henrik Ibsen’s An Enemy of the People springs to mind. I was given a copy on leaving Bristol.

What poem, song, or passage of prose would you like mourners at your funeral to hear?

I think “Amazing Grace” is a wonderful hymn.

What is your guiltiest pleasure?

Since my coronary artery surgery, anything served with cream.

If you could be invisible for a day what would you do?

I’d take the field with the English and Australian cricket teams on the first day of the Boxing Day Test at the Melbourne Cricket Ground.

What television programmes do you like?

I enjoy watching cricket and rugby test matches, documentaries, and detective series, especially Foyle’s War.

What is your most treasured possession?

Maggie and my family. They would seriously dispute that they’re possessions, but they’re what I treasure most.

What, if anything, are you doing to reduce your carbon footprint?

We have a solar hot water system on the house, we generate electricity from solar panels for domestic use and feed excess into the grid, and I drive a hybrid car. I also have a thriving worm farm.

What personal ambition do you still have?

I had the privilege of training and working in the NHS, which I continue to admire. I’d cherish the opportunity to provide genuine clinical leadership to perpetuate the original ideals of the service.

Summarise your personality in three words

Tolerant, humorous, friendly.

Where does alcohol fit into your life?

At serious wine tastings and easy going social events.

What is your pet hate?

Clinical incompetence, and clinicians and managers who don’t prioritise safe, high quality patient care.

What would be on the menu for your last supper?

Prawns in garlic butter; beef tournedos Rossini with dauphinois potatoes; rhubarb crumble with custard and cream; a cheese platter; and coffee.

Do you have any regrets about becoming a doctor?

No regrets whatsoever. I’m incredibly fortunate to be a medical practitioner, particularly at this time. My career spans some of the most exciting and innovative times for healthcare. In particular, technology has the potential to create safer, better, and more affordable health services for a greater number of people globally.

Physician Burnout Is a Public Health Crisis, Ethicist Says– MEDSCAPE

Hi. I’m Art Caplan from the Division of Medical Ethics at New York University Langone Medical Center. We’ve got a problem in this country with doctors. It’s kind of an epidemic, but no one is talking about it. It is burnout. A recent study from the Mayo Clinic showed that in 2011, 45.5% of doctors reported that they felt burned out, and that number has now risen to 54.4% in 2014.[1] More than half of all doctors in this country are saying, “I really feel that some aspect of my work as a doctor is making me feel burned out.”

This is really trouble. It’s trouble because a doctor who feels this way can commit more errors. They suffer from compassion fatigue, or just not being able to empathize with others because they have their own emotional issues. They may retire early, thereby reducing the workforce. They may have problems managing their own lives; 400 doctors committed suicide last year, which is double the rate of the population average.[2] There’s trouble for patients in having a workforce that’s burned out. There’s trouble for doctors in terms of their own health and well-being. We don’t talk about it much. We like to think that doctors can handle everything, but it’s clearly not true. It’s a problem and there ought to be some solutions.

One type of fix is to make sure that hospitals and other healthcare environments try to create better conditions for a happy workforce and for happier doctors……..

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